| NPI | 1700323037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801105106) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801100614) |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2023-03-28 |